Skin Lesions

VIP plastic surgeons accept referrals from your GP, dermatologist or directly.  They can remove unsightly or worrying moles, cysts and lipomas from all parts of the body.  Xanthelasma are deposits of cholesterol that occur on the upper and lower eyelid.  You should ask your GP to check your cholesterol levels, as it may be elevated.  They can be very obvious and are usually very easy to remove under local anaesthetic with minimal scarring.

One of VIP’s founding surgeons has a particular interest in the repair of the split earlobe and has published a technique to repair the earlobe whilst keeping the hole.  Again, this can be done under local anaesthetic as an outpatient procedure.

Skin cancers are increasingly common and it is important to be aware of the risks of sun exposure.  Fortunately, most can be treated successfully by excision under local anaesthetic.  The priority is to completely remove the tumour, but the cosmetic outcome is crucial.

VIP plastic surgeons take care to plan their excisions such that the resultant scars will lie in an area of a natural skin crease or shadow.  It is using this sort of planning that our plastic surgeons have gained the reputation for being able to perform scarless surgery.

No matter what the size or position of a lesion, it can be removed with maximum safety and minimum cosmetic deformity using plastic surgical techniques.  These range from careful excision and direct closure, through the use of skin grafts to flap techniques involving the movement of tissues from neighbouring skin or from elsewhere in the body.

Gynaecomastia

Gynaecomastia, or excessive breast growth in males (also known as man boobs or moobs), can be due to a number of causes. Hormonal imbalance is a major cause commonly due to the onset of puberty or rarely, a hormone-secreting tumour (eg. pituitary or testicular tumour).  Some men are treated for conditions such as prostate cancer or some of the complications associated with sickle-cell disease, with hormonal therapy and one of the side-effects of these treatments may be gynaecomastia.  Certain drugs may cause gynaecomastia such as marijuana or steroids, but the most common cause is idiopathic.  This means that no cause is found.

Gynaecomastia causes severe psychological and emotional distress as young men feel unable to take their shirt off in public and often feel uncomfortable wearing T-shirts or any tight top that may show the contour of the chest.

Gynaecomastia is certainly more obvious in obese patients and losing weight is the first line of treatment in this group.  For those patients that are not overweight, surgery is the only effective means of tackling the problem.  The surgical option used depends on the degree of gynaecomastia and whether or not there is skin excess.

    Mild gynaecomastia with no skin excess - liposuction is an effective treatment for this group of patients.  It leaves minimal scarring with only small stab incisions and will effectively remove the excess breast tissue as long as it is predominantly fatty.  Sometimes there is a dense nubbins of breast tissue behind the nipple that cannot be removed with liposuction.  In these cases, the tissue needs to be removed through an infra-areolar incision.  This is a half-moon shape incision below the nipple.  The scar is planned at the junction between the pigmented areolar skin and the paler skin of the chest wall.  By leaving the scar here, it is well hidden and is often difficult to see once the initial redness has faded.

    Moderate gynaecomastia with some skin excess - again liposuction forms the mainstay of treatment for these cases, but the possibility of an infra-areolar incision to remove the more dense tissue beneath the nipple is increased.  A modest amount of skin excess in a young healthy patient with good skin quality (non-smoker) would be expected to shrink and recoil once the underlying tissue was removed.  Alternatively, skin can be removed and the breast envelope tightened, but this involves more scars.  The scars involved in a modest skin reduction would be all the way around the nipple (circumareolar, as opposed to infra-areolar when only the breast tissue is removed, see above).  Again, this scar is relatively well hidden as it sits at the junction between the areolar and chest skin, but it is often puckered initially.  This is because as the skin envelope is tightened the excess slack skin is gathered up resulting in a puckered or 'pie crust' appearance to the circumareolar scar.  This puckered appearance will settle and flatten after some months.

    Severe gynaecomastia with skin excess - can be equivalent to a female breast reduction.  In these situations, there is a significant excess of both breast tissue and skin and it is difficult to address this without causing more extensive scarring.  The pattern of scars may vary, but the techniques all involve scars that extend on to the chest wall and so will be more visible than the infra-areolar or circumareolar scars.

Breast Reduction

Breast reduction surgery is associated with very high patient satisfaction rates because it delivers on several levels.  A breast reduction will not only reduce the size of the breast, but will also tighten the skin envelope and lift the breast in the same way that a mastopexy, or breast uplift will, giving a smaller and more youthful appearance.  Women with large breasts often suffer from bra straps digging in and back and neck ache, and reducing the weight of the breast will also often relieve the tension and help with these aches and pains.  The weight of large breasts can also cause recurrent inflammation and infections in the fold between the breast and the chest wall, known as intertrigo and this is eliminated or much improved following breast reduction.  Finally, there is the cost and inconvenience associated with finding a good bra in the larger sizes, and it can be an enormous relief to finally be able to shop in any high street department store.

Properly fitted bra

A well-fitting bra will go some way to reducing the discomfort associated with large breasts but it can be difficult to find an adequately fitting bra for the larger bust and the relief may not be total

Limitations of Surgery

It is important to be aware of the limitations and potential complications prior to embarking on surgery.  It is useful to have a cup size in mind to aim for but it is impossible to guarantee that this will be achieved.  There will always be a degree of swelling and the final result will not be apparent for some months following surgery and so it is unwise to go out and buy expensive bras too soon, when your cup size may change.

The nipple is moved during the procedure and so the sensation and blood supply may be interrupted.  The effect on lactation (breast feeding) is unpredictable and it may be that you will not be able to breast feed post-operatively.  If this is important to you, you should delay surgery until you have finished your family.

The scars will take about two weeks to be fully healed and may take longer in some cases.  They will be red for the first few months following surgery and can take 6-12 months to fully fade.

Mastopexy / Uplift

Breast tissue, like all tissues in the body, is subject to the forces of gravity.  This can be undesirable and create a droopy appearance which can be measured depending on how low the nipple has descended.  This is known as breast ptosis.  Breast ptosis is part of the normal ageing process, but can be exacerbated if the skin of the breast is stretched and then the stretching force is removed.

This commonly occurs after massive weight loss or following childbirth when the breasts become swollen and engorged.  This is also something to bear in mind if considering a large breast augmentation, as if, for any reason, the implants are removed, they will leave an empty droopy skin envelope that may need uplifting.

Mastopexy involves removal of skin to uplift the breast.  During the procedure, the nipple is lifted to a higher, more youthful position and the width of the breast is narrowed to create a more desirable, conical breast.

Breast Augmentation

Breast augmentation (breast enlargement, augmentation mammoplasty,
boob job) is one of the most widely performed cosmetic procedures and it is
associated with very high satisfaction rates. Enhancing the bust can have a
profound effect on your confidence and self-esteem. Whilst it is not without
potential complications (no surgery is), they are fortunately rare and the
psychological benefits can be immense.

Most patients come for breast augmentation after a lot of thought and research.
There is no substitute for a detailed discussion with your VIP surgeon, but you
may find the following information of interest….

Submuscular vs Subglandular Placement of Implants?

The breast is a modified sweat gland that sits on the pectoralis major
muscle (the so called ‘pecs’). Implants can be placed underneath the breast
itself (subglandular), or in a deeper plane beneath the pectoralis muscle
(submuscular). The subglandular plane is an easier dissection and so causes
less bleeding and pain post-operatively. For most patients with a modest size
breast, the subglandular plane is preferable.

For patients with very little breast tissue, it can be difficult to ‘hide’ the implant if
it is put beneath the gland. The edges of the implant may be palpable and there
may be rippling of the implant felt underneath the skin. For these reasons, the
submuscular plane is often more appropriate. By having the extra covering of
the pectoralis muscle, the implant is less easy to see or feel and the incidence of
capsular contracture is less.

Round vs Anatomical Shaped Implants?

Round implants are dome-shaped in cross-section, while anatomical implants
are tear-drop or pear-shaped (with a flat back).

Anatomically shaped implants have the advantage of giving a more natural
contour to the breast particularly in patients with little breast tissue.

However, they have the disadvantage of being more expensive and they have
the potential to rotate, producing an odd appearance which cannot happen with
round implants.

For patients with some breast tissue to cover the implant, the benefits of an
anatomical implant are less and in fact, a round implant can give a more pleasing
effect. A round implant gives more fullness in the upper pole which some
patients desire.

What Volume Implant Should I Have?

Patients tend to compare their implants by the volume of the implant. Whilst
this is obviously important, it is not the whole story.

The main determinant when it comes to choosing an implant, is the base
diameter of the breast. Once the diameter is measured, then the specific
implant is chosen depending on its projection, and for anatomical implants, its
height. Hence a 300cc implant with a low height and low projection, will look
different from a 300cc implant with a full height and projection (this implant will
necessarily have a smaller base diameter).

Whilst it is useful to have an idea of what volume implant you would like and
there are various ways to estimate this, such as adding a certain volume of rice
or water to a bag and putting it in your bra. These do not take into account the
different shapes implants of the same volume may have. The final choice is often
made by the surgeon to take in to account the other factors such as the base
diameter and projection.

For more information on Breast Augmentation or Breast Enlargement please click the links below

 

5 Top Tips To Prepare You for Breast Augmentation


An overview on Breast Enlargement


3 Typical Reasons for going under the knife and the Options on Breast Enlargement